Belgium

Education and training

program and examination for specialization
ORL training presently 5 years.
Phoniatrics not presently inluded.
Probably, according UEMS, duration will be extended to 6 years.
According to the residents choice, a 1-year training in phoniatics
will be offered. The residents are submitted to 2 controls,
one after 2 years and one after 5 years. If they succeed,
a certificate from the university is delivered.
Professional competence is delivered by a board (commission) in the
framework of the national healthcare ministry. Representatives of the
Universities and of the professional societies are included in this board.
There is a board for the Flemish part and a board for the French-speaking part (as usual in Belgium!).

Presently, any ENT-specialist interested in phoniatrics can consider
himself as a phoniatrician. But a 2-years program included in the 6-years ENT-training will probably be available, as a 2-years training in Head & Neck surgery or oto-neurosurgery... and a certificate with related exclusive competences should be delivered.
This special 2-years training will included all the topics , from the language to the swallowing disorders.

postgraduate programs
Presently there are no well-structured postgraduate programs.

Details

Société Scientifique et Union Professionnelle belge d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale
Commission d’Audio-Phoniatrie

Belgische Wetenschapelijke en Beroepsvereniging voor Oto-Rhino-Laryngologie Gelaats- en Halschirurgie
Commissie voor Audio-Foniatrie

SPEECH and LANGUAGE

A. TRUNCUS COMMUNIS

I. Anatomy
Bucco-pharyngeal pavilion and other cavity.
the mandible;
the pharynx;
the soft palate;
the mouth;
the nasal cavity;
the sinusal cavities.
Muscles of articulation
muscles of the Pharynx
the palatine muscles
muscles of the Mouth
muscles of the Jaw
muscles of the Tongue
fascials muscles .
Neuroanatomy
Cortical area
The reticular formation
The basal ganglia

II. Neurophysiology and physiopathology
Speech
elementary mouvments of the structures making up the
bucco-pharyngeal pavilion phonies and phonetics productions
points of articulation
functionnal modality of the points of articulation;

production of speech
temporal and frequential aspects of the speech the speech segments:
phoneme diphone et polysounds
prosodia
delivery (le débit)
accentuation
melody
articulation and intrinsic quality of the sound
variability of the speech signal
regulation of speech
influence of the hearing on voice and speech
voice and speech regulation

Language
Adults
Functionnal neurocognitives pathways
Brain and Language
Input and output pathways
secondary associative cortex
tertiary associative cortex
role of the mesiales and sub cortical structures in language
gradients of hemispheric dominance
Children
Anatomo-functionnal cerebral development and language
Morphogenesis : cytogenesis and cellular migration
Hodogenesis
Development of the hemispheric dominance for language
Maturation of mecanic constituants of the phono-articulatory
system (speech)
Breathing
Voice
Articulation
Learning and neuro-imprinting
Cerebral Plasticity
functional plasticity
Phenomenon of nervous supplenting when experimental and
pathological neurosensorial deprivation
Consequences of early hemispheric lesions

III. Neuropsychology

IV. Basic science of linguistic and communication
Psycholinguistic models
linguistic model - cognitive model - interaction model
Language emergence
precursors of language
selectif attention and categorical perception of the signs of speech
auditive perception of the signs of speech
prelinguistic stages
Development of linguistic systems
phonological system
lexical system
morphosyntatic system
pragmatic capacities
metalinguistic capacities

V. Diagnostic assesment
Medical examination
Audiological diagnostic
Neurophysiological examination
Radiological examination
Speech therapist examination
Exploration of oral language
Evaluation of scholastic learning
Neuropsychological evaluation
psychophysiological examination of the functional
hmispheric lateralisation for language
Evaluation of behavior

VI. Disorders and dysfunctions
A. Classification

Deficiency of the basic instruments
anatomical deficiency = dysglossia
sensory auditory deficiency = deafness hearinglos
disturbance of the command and the controle of the
bucco-pharyngeal motricity = dysarthria

Neurolinguistic disorders
pathology of oral language
gnostic deficits
praxical deficits
linguistic deficits
sycholinguistic deficits
pathology of written language

Stuttering

Language disorders due to psychopathology and deficiency
deficiency states
communication disorders

B. Specific syndromes
A. Children
Deafness and hearingloss
Early lesions syndroms, I.M.C.
Pseudobulbaires syndromes
Bucco-facial apraxia
Moebius syndrom
developmental dysphasia
Stuttering
Articulation disorders
Rhinolalia
Dyslalia
Dysarthria
Chilhood aphasia
Specific learning disorders
of reading = dyslexia
of writing = dysorthographia
of calculation = dyscalculia
Attention deficit and hyperreactivity
Language and mental impairment
Communication disorders in infantile autism
Affective disorders and language pathology

B. Adults
Deafness and hearingloss
Disorders of oral language
Articulation disorders
Rhinolalia
Aperta
Velum insufciency( postoperative or posttraumatic)
Paresia or isolated paralysis of the velum
Amyotrophic lateral sclerosis
Myopathy Myasthenia
Clausa
Obstructive pathology of the nose
Velo-palatal synechia
Tumor of the rhino -pharynx
Spastic neurological affection of the soft palate

Dyslalia
palatal vault anomalies
pharynx anomalies
tongue anomalies
lips anomalies
facial anomalies

Dysarthria
Cerebral motoric impairment
Progressive primitive myopathy
Amyotrophic lateral sclerosis
Familial hereditary ataxia =Friedreich syndrom
Multiple sclerosis
Parkinson’s disease
Post-encephalitic Parkinson syndrom
Wilson disease
Pseudo-bulbaire paralysis
General paralysis = Bayle disease

Stuttering

Pseudostuttering
Amyotrophic lateral sclerosis
Familial hereditary ataxia =Friedreich syndrom
Multiple sclerosis
Parkinson’s disease
Sydenham’s chorea (between 5-15 of age before disappearing )
Huntington’s chorea
Wilson disease
Pseudo-bulbaire paralysis
Epilepsy
Aphasie sequelae
Cranial trauma
Psychical trauma

Sputtering

Aphasia
Wernicke’s aphasia( sensory predominance)
Broca’s aphasia (motor predominance)
Aphasia dissociate
Pure anarthria
Pure agraphia
Pure verbal deafness
Pure verbal blindness or pure alexia

Dementia

Written language disorders
Dyslexia
Alexia
Dysorthographia
Agraphia
Dysgraphia
Dyscalculation

VII. Professional

VIII. Expertise

IX. Treatment
Medical aspects
Medication
Surgery to improve the speech cavity
adeno-tonsillectomy some time partial incomplete
Cleft palate surgery
Pharyngoplastic surgery
Frenulotomy
Medical or surgical treatment concerning deafness
or hearingloss Prosthesis

Orthodontia

Speechtherapy
articulation training
languagetherapy

Pedagogic-psychological treatment

Behaviortherapy

B. REFERENCES

-Decision making in speech-langage pathology. 1988. D. E. Yoder, R.D. Kent. B.C. Decker Inc.Toronto Philadelphia. 210 pp.

-Introduction to communication sciences and disorders. F.D. Minifie, 1995. Singular Publishing Group San Diego, U.S.A. 708 pp.

-Le Langage de l’enfant C. Chevrier-Muller, J. Narbona 1996. Masson, Paris 427 pp.

-Handbook of speech-language pathology and audiology N.J. Lass, L.V. Macreynolds, J.L. Northern, D.E. Yoder, B.C. Decker Inc. Toronto Philadelphia. 1988 1399pp.

SWALLOWING DISORDERS

A. TRUNCUS COMMUNIS

I. Anatomy

II. Neurophysiology and physiopathology
normal movements of swallowing
anatomy functional development
development of sucking-swallowing mechanism of new-born
and young child anatomical and physiological changes
from suckling to adult
influence of position or food consistency or ... on normal
swallowing physiology

III. Neuropsychology

IV. Diagnostic assessment
Anamnesis
Medical examination
Mirror
Flexible nasal endoscopy
Study of sensomotoric functions palato-pharyngeal
functions laryngeal functions

Radiological examination
Classical
Videofluoroscopy
Ultrasonography

Scintigraphy
Ph-measurement
Manometry
Oesophagoscopy
Electromyography

* Speech therapist examination

* Neuropsychological evaluation

VI. Disorders and dysfunctions
A.Children

Congenital or acquired pathology with consequence
of swallowing disorders deficiency of the basic instruments
cleft palate
cranio-facial malformations
obstructions

Gastro pharyngeal disorders (reflux...)
Neuromotoric disorders
Cardiopulmonary disorders
Sensory disorders
Behavior disorders

B. Adults
Deficiency at consequence of medical history
sequel of radiotherapy
behavior of the patient

E.NT, etiology
congenital deficiency
infections
oncology
corpora aliena
globus ....
canula influence also without inflated cuff
relation between speech-languagequality and swallowing disorders

Oesophageal diseases
Achalasia
Pyrosis
thermic/mechanic lesions
oncology
corpora alinea

Neurological lesions
CVA
Degenerative neurological pathology
ALS
MS

Consequences of surgical therapy and sequels

Knowledge of the severe psycho-social consequences
of swallowing disorders

VII. Professional

VIII. Expertise

IX.Treatment
Circumstances that determine the choice of therapy

Medical aspects
Medication
Surgery
Myotomy
laryngeale suspension
prosthesis

Orthodontia

Speechtherapy
position adaptations
material adaptation by children
food adaptation by modification of consistency or/and
temperature modification of sensory input
sensory desensitization
facilitating techniques
arbitrary changes in swallowing physiology

Alternative ways of nutrition
veinous alimentation
stomach tube
gastrostomy
diet aspects

B. REFERENCES

C. ABILITY ATTAINMENTS by

practice of the E.N. T. component of the diagnosis
practice of the E.N. T. component of therapy
collaboration in team approach about diagnosis, therapy and
readaptation with specialist in gastro-enterologic diseases
radiologist
speechtherapist
pediatrician

D. OPTIONAL
participation in scientific study concerning swallowing

Everyone of us is free to attend the scientific meetings of his/her choice

Associations

Scientific
name: European Laryngological Society .
This society was founded in January 1995 under the presidency of Oskar
Kleinsasser.
The main goal of this society is to deal with all the aspects of
laryngology from cancer to voice assessments

contact address: Marc Remacle, general secretary
University hospital of Louvain at Mont-Godinne, 5530 Yvoir
fax: +32 81423703
phone: + 32 81423021
e-mail: remacle@orlo.ucl.ac.be
web site: http://www.md.ucl.ac.be/mont/chirurg/orl/larynx/els/els.htm

Professional

name: working group on audio-phoniatrics
contact address: chair: Willy Wellens, University of Leuven

Outstanding personalities

c.f. history: chapter on phoniatrics from Ph Dejonckere
living: Willy Wellens,KUL; Philippe Dejonckere, presently in Utrecht